- 1 anterior odontoid joint

- 2 superior facet joints

- 2 inferior facet joints

- 2 superior facet joints

- 2 inferior facet joints

-2 odontoid (ant. & post.)

- 2 Von Luschka

-1 intervertebral disc joint

- 2 superior facet joints

- 2 inferior facet joints

- 4 Von Luschka joints

- 2 intervertebral disc joints

- 2 superior facet joints (synovial)

- 2 inferior facet joints (synovial)

- 2 intervertbral disc joints (fibrocartilaginous)

- 4 costovertebral joints

- 2 costotransverse joints

- 2 superior facet joints

- 2 inferior facet joints

- 2 disc joints

- 1 sacral coccygeal joint

- 1 L5-S1 disc joint

- 2 L5-S1 superior articular facets (junctions)

- 2 SI joints

L5

(because L5 nerve root is still in the canal)

A segment.

The inferior half of 1 vertebrae above, the superior half of the vertebrae below and everything including disc, nerve, blood vessels inbetween.

Pars interarticularis

Scotty dog fracture

-myotomes

-dermatomes

-neural reflexes

-neural tension

10

-only the the intervertebral disc are fibrocartilaginous not synovial

-vertebral artery

-C6

They prevent lateral herniation and help stabilize the disc.

(the uncinate processes are WB and take pressure off of the disc)

Because in the C spine they are more anterior/lateral, while in the T spine they are more posterior.

-downs syndrome

-pregnancy

-RA (attacks the synovium of the joints causing high susceptibility to instability in the C spine. Therefore people with RA are directly contraindicated for manipulation)

-transverse ligament

-hyaline cartilage

arthrokinematics- motion within the joint (roll/glide)

osteokinematics- the resultant movement of the limb (flexion/extension)

Motions that take place in a joint to facilitate a particular active motion. Motion that takes place between 2 joint surfaces and takes place from natural classical motion.

(under voluntary control i.e. roll/glide)

Occurs only in response to an outside force.

(not under voluntary control)

ex: distraction

1. The PLL is very wide in the cervical and becomes more narrow in the lumbar spine.

2. No uncinate processes are in the lumbar spine.

3. The lumbar spine has more weight and increased force production

4. Nucleus pulposus is more posteriorly located in the lumbar spine and more anterior in the cervial spine.

5. lateral walls of the Von Luschka prevent herniation

6. The disc begin to dry out in the lumnbar spine by age 55-60.

- supine with legs  at 90 90

(within 1 hour, 80% imbibition occurs)

- incident in gymnasium

- his father's story

1. Manipulate in the direction of least restriction

2. cause no pain

These rules apply to gross techniques of manipulation for those that are less trained in manipulation

He was an MD and DO and was a great maniplator who used spring testing techniques (to sense resistance to pressure)

He believed that back pain came from the SI joint, the disc and the facets (compare to Paris and Cyriax)

-the convex-concave rule

-he gave classifications to graded movement with traction (i.e. PA glides are easier with a grade I distraction vesus a grade II)

-used manipulation techniques to treat ‘reproducable s/sx’ rather than to reduce a disc and developed graded oscillations and concepts such as reactivity.

-Stanley Paris

-It includes a classification system that is a hybrid of Kaltenborn's and Stoddard's that talked about movement. This system is called 'passive intervertebral motion' or 'PIVM' (see separate card)

0 fused-no therapy

1 considerable restriction-non thrust

2 slight restriction- non thrust to thrust (be careful!)

3 normal-

4 slight increase-

5 considerable increase- stabilization (posture training)

6 unstable-stabilization to surgery

  The body works on DIAGONALS , not on sagittal or frontal. 

-abd of the shoulder joint should be measured more in the scapular plane. -Straight abd is considered ER and straight flexion is IR and scaption is neutral.

-his techniques involve repetitive motion  -Repeptitive ext is good for pts and pain is often centralized.

-just like Codman noticed if u do back and forth motions to the shoulder, u can centralize pain, McKenzie saw this in the back too by using repetitive motion. (He assumed he was putting the disc back into place. By MRIs and CTs we now see that is impossible.)

 -He developed concepts of performing manipulation with active movements along facet planes. He manipulated with movement (pts do AROM at same time).

-Having the pt help u manipulate their joints is a therapeutic advantage.

(he wrote the chapter on traction in Paris’s “The Spinal Lesion” book.)

-it was around in the 1920s but faded out (was taken by chiropractors)

-there was a rebirth in the 1960s

1961-no manipulation in US, only done by chiropractors

1963- Paris comes to Boston and the Dean at Allied Health at Boston U said PTs were not allowed to perform, teach, write, etc about manipulation

1967- North American Academy of Manipulation Medicine is founded and PTs aren’t welcome, only physicians (founded by Trevell, Maigne and Mennell).

1967-APTA turns down request for manipulation section.

1968-North American Academy of Manipulative Therapy is formed in Boston.

"the skilled passive movement to a joint"

later changed to "the skilled passive movement to a joint with a therapeutic intent"

-Stanley Paris

-  To be in IFOMT u had to pass an exam within the orthopaedic section of the APTA unlike any other section

In 1979 the following activities in Atlanta, Ga enabled the formation of USA:

-Atlanta back clinic (first multidisciplinary clinic in the country and owned and run by a PT)

-southwestern clinics (West Paces ferry Headache and Facial Pain clinic, Back School of atl, Clayton General hospital)

-Doctoral Studies

-Institute of PT 

(The Institute of Graduate Health Sciences became the University)

-FIRST proprietary school of PT and OT

-One of the first to offer the DPT and the t-DPT and t-OTD

-The only school to offer the dual degree

-The first to offer a full on-line DPT option (boca raton and san diego)

-Also offers DHSc and EdD- mostly online

-2^nd campus in San Diego

They use a modified version of Paris's definition.

Who created a classification of "end feels"?

what does it refer to?

-Paris and Patla have identified 5 normal and 9 abnormal end feels

- it is about the sense of motion at the end of a passive range. Differentiating between them helps PTs to select the correct treatments.

Normal:

Muscle- as in SLR

Ligament-as in knee abd

Capsule- shoulder elevation

Cartilage- elbow ext

Soft tissue- knee flexion

In 1996- a large breakthrough in evidence of MT occurred when the Agency for Health Care Policy and Research (AHCPR) said that valid literature was a milestone in the acceptance of MT.

They said the tx of acute low back pain included MT amongst others such as posture training.

-paresis does not require immediate surgery (wait 2 months).

-Conservative management (medical+ sometimes PT) is equal to or better than surgery -PT and surgery both have a 70% success rate. -Aggressive rehab (medical, injection+ stabilization) gives 90% improvement @ 31 months –young age is a positive factor.

1.       Those that tx s/sx: Maitland, McKenzie, Cyriax (disc), Sarhmann

2.       Those that tx dysfunction: Kaltenborn, Paris, Mulligan, Osteopathy, Chiropractic

Spinal instability: is where the osseo-ligamentous and or neuromuscular component of the spinal segment are unable to hold the segment either in spinal neutral or at other points in range, against creep and slippage and other aberrant motions (paris)

-it is not hyper mobility

- it is a patho-anatomical entity

-it is quite common

- single largest reason for back pain

- it is treatable

- stabilization will reduce/remove the pain

-thus, instability can become a stabilized and painless hypermobility

(Tight joints lead to instabilities

Hypermobility is NOT instability (until or unless fatigued)

In an unstable spine with a torn disc, forward bending extrudes the disc and backward bending extrudes it further back.)

If the outer capsule tears (outer rings of annulus) u will see an effort at healing bc the otter portions are vascularized. These pts need to be treated with stabilization exercises to stop a further herniation through the tear.

A normal healthy disc has no innervations so has no way of conducting pain except from its periphery where it IS innervated. However, a degenerated disc is painful bc nerves accompany the ingrowth of vascularization and other materials (bloody disc)

education

exercise

manipulation

Classical movement- active, passive

Accessory Movement- component motion, joint play

Manipulation- distraction, non-thrust, thrust

osteokinematic

forward bending, side-bending, backward bending, rotation

1. Physical- actual tissue damage

2. Emotional- anxiety

3. Rational- patient's understanding

1. Have the patient lie prone with pillow under abdomen and observe for changes. If it changes it is an unstable spondylolistheses. If it does not change it is an anomaly or a stable spondylolisthesis.

2. Look at standing versus prone tone and shaking with AROM indicative of stable spondylolisthesis.

PT, Ph.D., FAPTA

FNZSP, NZMTA (hon. life), IFOMT (founder+hon life) FAAOPMT, MCSP

Abrose Pare

  in its original form means “straight child”

Wharton Hood

1870 (*key date)

1896

DD Plamer and his son BJ Palmer

the body will be healthy at all times provided the vital nerve forces are intact. Vital force is interrupted with vertebrae subluxation(although this cause is not supported by evidence)

this law refers to chiropractic

great toe flexion (FHL)

or

plantar flexion (gastroc/soleus)

1. bosses and bars

2. ligamentum flavum

3. disc

4. posterior longitudinal ligament

leg length discrepency

pronated foot

-pelvic torsional rotation

-anomaly

-muscular imbalance

-scoliosis

-SI torsion/ rotation

-avascular necrosis (Legg-Calve Perthes Disease)

-asymmetrical femoral neck angle

-slipped femoral epiphysis

-DJD of hip

stiffness

-there will also be an area of compensation that must act as a hinge

motions that are normally performed throughout the day (i.e. FB, BB, trunk rot)

-in fxn'l SB of the neck, the head follows the neck to look in front of the shoulder

this applies to SIDE BENDING

it describes the motions are not normally performed (i.e. neck or trunk SB in the frontal plane)

Fxn'l SB: causes rot to same side in midcervical and subcranial spines (due to facet planes)

non-fxn'l SB: causes rot to same side in the midcervical spine but rotation in the OPPOSITE direction in the subcranial spine

OPPOSITE

(rot R and SB L to keep head from cocking)

the atlas follows the occiput

(moves posterior in BB, anterior in FB, L in L SB and R in R SB)

What are some symptoms of subcranial instability due to a torn subcranial ligament?

what causes these symptoms?

trouble speaking and difficulty swallowing

this is due to compression of the hypoglossal nerve

-facets translate up and fwd (40% displacement)

-lateral interbody articulations translate anteriorly (more than lumbar spine due to von lushka jnts)

-intervertebral discs bulge anteriorly, flatten posteriorly

-spinal canal lengthens

-canal also narrows but volume remains the SAME

-facets translate down and back

-at end range the facet tilts and gaps superiorly

-lateral interbody joints translate POSTERIORLY

-the spinal canal NARROWS and shortens

-disc and lig flava bulge into the spinal canal

-each vdrtebrae steps back on the one below

she may have buckling of the lig flava with calcification or bone spurs causing central stenosis and myelopathy.

you may test babinski and clonus to see CNS pathology

in a healthy disc the NP translates anteriorly

in a nonhealthy disc the NP follows the last of least resistance sending it further backward

1.gate control theory: firing of mechanoreceptors in post. annulus and facets will gate pain

2. elevates the H2O content of the disc by repetitive motion (makes it less acidic)

3. mobilizes the facet joints more than FB!

4. promotes circulation flushing away chem irritants

5. relieves the fear of movement

6. neural tension is reduced due to slackening of cauda equina

7. over time the disc protrusion looses proteoglycans and its ability to attract H2O and thus shrinks

happens smoothly regardless of speed

relaxation of antagonist

full range-according to body type

pain free

normal strength of muscles

PROM>AROM

limited range

unwillingness to move

pain during or at end range

painful arc

compensatory or 'trick' movements

signs of instability (see other card)

FB=deviation to the left

BB=deviation to the right

SBR=limited

RL=limited

SBL=free

RR=free

lumbar=FB limited all other mvmts are relatively free

cervical=no consistent pattern; depends on muscles involved

1. Hx or demonstration of tissue relaxation/creep

-inability to sit for long periods

-discomfort increases as the day progresses and relieved by mvmt or rest

2. increased muscle tone while standing

3. presence of a 'step' or rotation (spondylolysthesis, retrolisthesis, or spondylolysis)

4. disappearance of muscle tone, step or rotation in prone lying

5. shaking with FB

6. difficulty in coming upright from FB

7. grade 5 or 6 on passive motion palpation

8. radiological evidence of motion studies of FB and BB showing incr. angulation btwn vertebrae and more imprtantly=excessive translation

smooth transition of motion

increase of the thoracic kyphosis

loss of reversal of lumbar lordosis

role of the hip

signs of instability

FB=possible deviation L

BB=deviate R

SBR=restricted

RR=most restricted

SBL=relatively free

RL=relatively free

FB=US B

BB=DS B

SBR= DS R, US L

RR= DS R, US L

SBL= DS L, US R

RL=DS L, US R

(SBR and RR are 'coupled motions')

(less consistent than lumbar spine)

T3/4 and above are cervical (no gapping)

T3/4 and below move as lumbar